Provider Demographics
NPI:1457704595
Name:WELCH, RANDI MARIE (LGADC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:MARIE
Last Name:WELCH
Suffix:
Gender:F
Credentials:LGADC
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:MARIE
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:215 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-1012
Mailing Address - Country:US
Mailing Address - Phone:410-754-9021
Mailing Address - Fax:833-908-2285
Practice Address - Street 1:215 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-1012
Practice Address - Country:US
Practice Address - Phone:410-754-9021
Practice Address - Fax:833-908-2285
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14360101YP2500X, 101YM0800X
MDLCA3010101YA0400X
MDAC2556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520202701Medicaid
MD520202703Medicaid